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#PubSaludMurcia SynPAR for Empirical Membership Inference Auditing of Synthetic Radiomic and Embedding Data @Area6VegaMedia

SynPAR for Empirical Membership Inference Auditing of Synthetic Radiomic and Embedding Data - Journal of Imaging Informatics in Medicine

To develop and evaluate SynPAR, a framework for reproducible membership-inference auditing and reporting of synthetic radiomic and embedding data. We evaluated feature releases from eight imaging cohorts using distance, density-ratio, and shadow-calibrated attacks. Reference-overlap experiments tested evaluation contamination. Graded exact-copy controls, with separate threshold-calibration and test records, measured discrimination and sensitivity at false-positive-rate (FPR) targets of 1%, 5%, and 10%. Findings informed a seven-item reporting checklist. Reference overlap increased mean density-ratio area under the receiver-operating-characteristic curve (AUC) from 0.502 to 0.809 across five cohorts. Distance-shadow versus shadow-standardized density AUCs were 0.630 versus 0.523 for the conditional variational autoencoder and 0.584 versus 0.521 for the Wasserstein generative adversarial network; both diffusion implementations were near chance under distance-shadow testing. Across 380 controlled release conditions, sensitivity depended on copying fraction and operating point. With complete copying in independent normal-feature experiments, shadow-standardized density achieved AUC 0.967 but sensitivity 0.480 at rank-calibrated target 1% FPR (achieved 1.04%); distance achieved 1.000 for both, with achieved FPR 1.00%. SynPAR links reference checks and measured sensitivity to practical reporting recommendations. The findings support assessing discrimination and sensitivity to known exposure jointly at explicitly evaluated operating points when interpreting attack results.

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#PubSaludMurcia Quality metrics of synthetic radiomics data do not predict improvement under simulated external validation: an ecological fallacy across 50 public datasets @Area6VegaMedia

Quality metrics of synthetic radiomics data do not predict improvement under simulated external validation: an ecological fallacy across 50 public datasets - European Radiology

Objectives To investigate whether established synthetic data quality metrics predict when deep generative augmentation improves performance under simulated external validation in radiomics. Materials and methods Three conditional generators (WGAN-GP, CVAE, TabDDPM) were trained on 50 public binary-classification radiomic datasets from radMLBench. For each dataset–generator pair (n = 150), five quality metrics and ΔAUC (change in simulated external AUC under domain shift) were recorded across 10 repetitions; undefined AUCs (single-class test folds) were excluded a priori (30/2500 external, 1.2%). Six analyses tested quality–ΔAUC associations: rank correlations with FDR correction, ROC discrimination, subgroup random-effects meta-analysis, composite scoring, quality-guided generator selection, and SMOTE comparison. All experiments were replicated with a random forest classifier. Results Pooled quality metrics correlated significantly with ΔAUC (|ρ| = 0.30–0.36, all adjusted p < 0.001); within each generator, all correlations were non-significant (all p > 0.05), revealing an ecological fallacy. After Benjamini–Hochberg correction, 5 of 20 correlations survived: the 4 pooled associations and DDPM MMD (unexpected direction). ROC-AUC ranged from 0.42 to 0.61 (near-chance). Quality-guided selection yielded a significantly negative pooled Δ (−0.0051; 95% CI: −0.0083 to −0.0019) and improved external AUC in only 17/50 (34%) datasets versus 34/50 (68%) for an oracle. Random forest replication rendered pooled correlations non-significant (all p > 0.09). A pre-specified sensitivity analysis on the 29/50 datasets statistically distinguishable from chance produced identical conclusions. Conclusion Aggregate quality–performance correlations are driven by between-generator differences, not within-generator variation that could guide practical decisions. Quality metrics are insufficient proxies for clinical utility; task-specific external validation remains indispensable. Key Points Question Can established quality metrics of synthetic radiomics data identify when generative augmentation actually improves the performance of prediction models under simulated external validation? Findings Across 50 public datasets, aggregate quality–performance correlations vanished within individual generators (ecological fallacy), and quality-guided generator selection underperformed real-only training. Clinical relevance Quality metrics commonly used to validate synthetic radiomics data cannot identify when augmentation improves clinical model performance under simulated domain shift, underscoring the irreplaceable role of task-specific external validation before clinical deployment. Graphical Abstract

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#PubSaludMurcia Historical Evolution of Pelvic Exenteration Surgery in Gynecologic Cancers: A Systematic Review and Meta-Analysis of Brunschwig's Era versus Contemporary Practice @AreaUnoArrixaca

Historical Evolution of Pelvic Exenteration Surgery in Gynecologic Cancers: A Systematic Review and Meta-Analysis of Brunschwig’s Era versus Contemporary Practice - Annals of Surgical Oncology

Background Pelvic exenteration (PE) is a radical surgical option for locally advanced or recurrent gynecologic cancers, but its contemporary risk–benefit profile has never been systematically compared with the original Brunschwig experience. The purpose of the study was to quantify changes in major postoperative morbidity, perioperative mortality, and oncologic outcomes after PE between Brunschwig-era series (1954–1969) and contemporary series (1990–2024). Materials and Methods This was an International Prospective Register of Systematic Reviews (PROSPERO)-registered (CRD420251009209) systematic review and meta-analysis. PubMed/MEDLINE, Web of Science, and Scopus were searched through December 2024 for studies reporting complications, mortality, or survival after pelvic exenteration for gynecologic malignancies. Two reviewers independently performed study selection and data extraction. Major morbidity was harmonized to Clavien–Dindo grade III or higher (or equivalent). Random-effects meta-analyses were performed where appropriate. All eligible studies identified were retrospective series. Results A total of 34 studies (5478 patients; 913 historical and 4565 contemporary) were included. Major morbidity decreased from 58% (95% CI 46–68%) in historical series to 23% (95% CI 17–31%) in contemporary series, while perioperative mortality declined from 23 (95% CI 17–30%) to 3% (95% CI 2–4%). Contemporary series also reported improved oncologic outcomes, although heterogeneity and differences in follow-up precluded direct survival comparisons. Conclusions Compared with the original Brunschwig era, contemporary pelvic exenteration is associated with substantially lower major morbidity and perioperative mortality, together with improved oncologic outcomes. These findings illustrate the remarkable technical and conceptual evolution of pelvic exenteration over the past seven decades, although direct comparisons between historical and contemporary series should be interpreted cautiously because of differences in patient selection and clinical practice over time.

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#PubSaludMurcia Lifting the radiomics performance ceiling: how preprocessing leakage amplifies model multiplicity @Area6VegaMedia

Lifting the radiomics performance ceiling: how preprocessing leakage amplifies model multiplicity - European Radiology

Objectives To jointly quantify and causally link preprocessing leakage, analytical flexibility and the Rashomon effect in radiomics-based clinical prediction models. Materials and methods Retrospective methodological (specification-curve) analysis of 50 de-identified binary-classification datasets in radMLBench (multicentre; 13 anatomical sites; CT, MRI, PET/CT; median 147 patients per dataset, range 51–969); prediction-model reporting followed CLAIM 2.0 and TRIPOD + AI 2024. We enumerated an analytical multiverse of 456 pipeline specifications (3 scalers × 2 correlation filters × 19 feature selectors × 4 classifiers), each evaluated against the dataset label by 5-fold cross-validation × 10 repetitions. Feature-level preprocessing leakage was assessed by paired global-versus-nested comparison for the synthetic minority oversampling technique (SMOTE), normalisation, correlation filtering and principal component analysis (PCA), pooled by DerSimonian–Laird meta-analysis. Within-subjects causal mediation (43 datasets) tested whether inflation of the best area under the receiver operating characteristic curve (AUC) explains leakage-induced Rashomon-set expansion. Results Across the 50 datasets, SMOTE leakage inflated AUC by a pooled 0.09 (95% confidence interval (CI): 0.07, 0.11; p < 0.001), exceeding 0.05 in 64%. Pipeline choice shifted AUC by 0.30, classifier dominating (eta-squared = 0.21). At ε = 5%, near-optimal pipelines disagreed on 20–30% of patient classifications (Fleiss kappa = 0.58) and shared < 30% of top features. SMOTE leakage quadrupled the Rashomon set (0.06 to 0.23; p < 0.001); 79% mediated by best-AUC inflation. Radiomics showed 4.8× wider vibration of effects (VoE) but 13× smaller Rashomon ratios than eight tabular benchmarks (both p < 0.001). Conclusion The three sources compound; leakage amplifies model multiplicity by inflating the performance ceiling. Key Points Question Whether preprocessing leakage, analytical flexibility and the Rashomon effect jointly compromise the reproducibility of radiomics-based clinical prediction models has not been quantified. Findings Across 50 radiomics datasets, SMOTE leakage inflated AUC by 0.09 and quadrupled the Rashomon set, with 79% causally mediated by best-AUC inflation. Clinical relevance Radiomics-derived clinical prediction models routinely disagree on 20–30% of patients while appearing equally near-optimal. The released three-layer audit tool quantifies this risk per study and should precede any clinical deployment claim. Graphical Abstract

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#PubSaludMurcia Lifting the radiomics performance ceiling: how preprocessing leakage amplifies model multiplicity @Area6VegaMedia

Lifting the radiomics performance ceiling: how preprocessing leakage amplifies model multiplicity - European Radiology

Objectives To jointly quantify and causally link preprocessing leakage, analytical flexibility and the Rashomon effect in radiomics-based clinical prediction models. Materials and methods Retrospective methodological (specification-curve) analysis of 50 de-identified binary-classification datasets in radMLBench (multicentre; 13 anatomical sites; CT, MRI, PET/CT; median 147 patients per dataset, range 51–969); prediction-model reporting followed CLAIM 2.0 and TRIPOD + AI 2024. We enumerated an analytical multiverse of 456 pipeline specifications (3 scalers × 2 correlation filters × 19 feature selectors × 4 classifiers), each evaluated against the dataset label by 5-fold cross-validation × 10 repetitions. Feature-level preprocessing leakage was assessed by paired global-versus-nested comparison for the synthetic minority oversampling technique (SMOTE), normalisation, correlation filtering and principal component analysis (PCA), pooled by DerSimonian–Laird meta-analysis. Within-subjects causal mediation (43 datasets) tested whether inflation of the best area under the receiver operating characteristic curve (AUC) explains leakage-induced Rashomon-set expansion. Results Across the 50 datasets, SMOTE leakage inflated AUC by a pooled 0.09 (95% confidence interval (CI): 0.07, 0.11; p < 0.001), exceeding 0.05 in 64%. Pipeline choice shifted AUC by 0.30, classifier dominating (eta-squared = 0.21). At ε = 5%, near-optimal pipelines disagreed on 20–30% of patient classifications (Fleiss kappa = 0.58) and shared < 30% of top features. SMOTE leakage quadrupled the Rashomon set (0.06 to 0.23; p < 0.001); 79% mediated by best-AUC inflation. Radiomics showed 4.8× wider vibration of effects (VoE) but 13× smaller Rashomon ratios than eight tabular benchmarks (both p < 0.001). Conclusion The three sources compound; leakage amplifies model multiplicity by inflating the performance ceiling. Key Points Question Whether preprocessing leakage, analytical flexibility and the Rashomon effect jointly compromise the reproducibility of radiomics-based clinical prediction models has not been quantified. Findings Across 50 radiomics datasets, SMOTE leakage inflated AUC by 0.09 and quadrupled the Rashomon set, with 79% causally mediated by best-AUC inflation. Clinical relevance Radiomics-derived clinical prediction models routinely disagree on 20–30% of patients while appearing equally near-optimal. The released three-layer audit tool quantifies this risk per study and should precede any clinical deployment claim. Graphical Abstract

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#PubSaludMurcia Venous and arterial thromboembolic events associated with osimertinib in patients with lung cancer: a study by the thrombosis and cancer group of the spanish society of medical oncology (SEOM) @Area6VegaMedia

Venous and arterial thromboembolic events associated with osimertinib in patients with lung cancer: a study by the thrombosis and cancer group of the spanish society of medical oncology (SEOM) - Clinical and Translational Oncology

Purpose To determine the real-world clinical practice incidence and predictive factors of venous and arterial thromboembolic events (VTE/ATE) in lung cancer patients treated with osimertinib. Methods/patients A multicenter retrospective study including 546 lung cancer patients who initiated treatment with osimertinib before or during 2024, with a minimum follow-up of 6 months. The primary objective was to evaluate the incidence of VTE/ATE. Secondary objectives included identifying predictive factors for thrombosis and assessing its impact on overall survival (OS). Competing risk regression (Fine-Gray), multivariable Cox models, and Kaplan–Meier analyses (including landmark analysis at 6 months) adjusted for time-dependent covariates were performed to prevent immortal time bias. Missing data were handled using a complete-case strategy (n = 544) given <0.5% missingness in model covariates. Results Overall VTE/ATE incidence was 15.0% (82/546; 10.5 events per 100 person-years)[cite: 3, 4]. The cumulative incidence of first VTE/ATE (accounting for non-thrombotic death as a competing risk) was 8.34% (95% CI 6.08–10.74%) at 6 months and 10.54% (95% CI 7.96–13.21%) at 12 months. In the multivariable Fine-Gray model, higher body mass index (BMI) (sHR 1.07; 95% CI 1.02–1.12; p = 0.009) and central nervous system (CNS) metastases (sHR 2.30; 95% CI 1.30–4.07; p = 0.004) were independently associated with VTE/ATE. Metastatic recurrence versus de novo stage IV showed no association with thrombosis (sHR 0.85; 95% CI 0.48–1.50; p = 0.573). Median OS was significantly shorter in patients with VTE/ATE (22.0 vs. 31.0 months; log-rank p = 0.049). Modeled as a time-dependent covariate, thrombosis significantly increased mortality hazard (HR 2.43; 95% CI 1.78–3.33; p < 0.001). Sensitivity analysis excluding events at tumor progression confirmed these associations (Cox HR 1.78; p = 0.002). Neoplastic progression accounted for 77.5% of total deaths and 64.9% of deaths in patients with thrombosis. Conclusions The incidence of thromboembolic events during osimertinib treatment in routine practice was 15.0% and was associated with poorer overall survival. Elevated BMI and CNS metastases identify higher-risk patients, providing a rationale for evaluating individualized risk stratification in future prospective clinical trials.

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